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THE CSTE WASHINGTON REPORT
Marcia S. Mabee, MPH, PhD
Editor
11479 Waterview
Reston, Virginia 20190
mmabee@ix.netcom.com
703-709-3001
September 13, 2001 Volume 5, Number 17
EDITOR’S NOTE: The Washington budget landscape was significantly altered
by the catastrophic events of Tuesday, with the President and the Congress
expected to place priority on fast track legislation to fund New York and
Washington recovery from the devastating attacks of terrorists as well as
to significantly bolster national security measures. The ongoing
appropriations process is on hold given Tuesday’s events, with no
immediate indication of when the regular spending bills will be marked up.
Meanwhile, the aftermath of Tuesday’s attacks on civilian populations has
dramatically altered the American public’s perception of terrorism and the
government’s role in protecting the public’s safety -- a somber reminder
of the vulnerabilities of a democratic state.
The CSTE Washington Report is provided as a information resource for
members of the Council of State and Territorial Epidemiologists on federal
legislation and regulation affecting public health and epidemiology in the
U.S. Regulations cited can be accessed via http:
www.gpo.gov
A SMALL GENETIC CHANGE MAKES FLU VIRUS DEADLY -- A tiny
change in one of the influenza virus's 10 genes is key to making certain
strains of the virus especially virulent to humans, scientists report in
the Sept. 7 issue of Science. This discovery helps explain why an
influenza outbreak four years ago in Hong Kong killed an unusually high
proportion of the people it infected, six out of 18, says lead researcher
Yoshihiro Kawaoka, D.V.M., Ph.D., of the University of Wisconsin-Madison.
"We have found that a limited number of very tiny genetic changes in a
specific gene, one called PB2, can have a big effect on how potent the
influenza virus is," says Dr. Kawaoka, a grantee of the National Institute
of Allergy and Infectious Diseases (NIAID). "Because the influenza virus
constantly mutates, and because only a few changes can make a
non-pathogenic virus highly pathogenic, we should assume that an outbreak
of any new strain or subtype is potentially dangerous to humans."
"To prepare for future influenza pandemics, NIAID has supported efforts to
understand how new virus strains potentially harmful to humans appear,"
says Anthony S. Fauci, M.D., NIAID director. "This study is an elegant
example of research that provides insight into the emergence of virulent
viruses and can help us develop better strategies for detecting future
outbreaks."
Wild waterfowl are natural reservoirs for the influenza virus; these birds
transmit the virus to pigs or chickens, which then pass it on to people.
The deadly outbreak of influenza virus subtype H5N1 in Hong Kong in 1997
was the first documented case of an influenza virus jumping directly from
chickens to people. Public health authorities responded by ordering the
slaughter of more than 1 million live poultry to prevent further spread of
the virus to humans.
Dr. Kawaoka and colleagues obtained samples of the H5N1 viruses that had
infected Hong Kong residents during the 1997 outbreak. Testing these
viruses in laboratory mice, the researchers found good correlation between
how sick certain H5N1 strains made mice and how sick they had made humans.
The researchers divided the H5N1 strains into two groups: one that caused
systemic lethal infection in the mice and one that was relatively benign.
Mice are a good model for studying H5N1, Dr. Kawaoka says, because this
virus affects mice and humans similarly.
Next, Dr. Kawaoka used a technology that allows him to genetically
engineer "designer" influenza viruses from scratch. By systematically
swapping the genes from the harmful and benign viruses, then testing how
those engineered viruses affected mice, he discovered that the PB2 gene
from the harmful group gives the virus its potency. Then, through testing
viruses that contained variations of this PB2 gene, he further identified
a tiny change within the gene, a change of just one unit of RNA, that
appears to be key to the virus's virulence.
The function of the PB2 gene is not completely understood, but scientists
believe it codes for an enzyme that helps force the host cell's molecular
machinery to make more viruses, Dr. Kawaoka explains. "We don't know if
the mutation we studied is involved in that process, but our next step
will be to find out," he says.
HHS LAUNCHES NEW WEB SITE DEDICATED TO GLOBAL HEALTH ISSUES -- HHS
Secretary Tommy G. Thompson announced the launch of a new Web site that
addresses the inextricable link between domestic and international health
issues. The site, "http://www.globalhealth.gov"
provides information on the department's work on global health issues as
well as worldwide health statistics, reports and publications, and links
to the department's global health partners.
"The global health challenges for this new century are daunting. These
problems require a solution that is driven by compassion and that includes
the very best research, practice and service from HHS," said Secretary
Thompson. "Because our health, economies and humanitarian values have
become truly global in nature, our responses must likewise be global in
nature."
The site was developed to be a portal of global health information for
policymakers, researchers, doctors and the general public. It underscores
the administration's commitment to health as a priority in America and
worldwide.
HHS works with partners from around the world to combat global health
problems such as AIDS, malaria, tuberculosis and tobacco use. The ease of
travel in today's global economy means that no nation can be isolated from
global health threats. The movement of more than 2 million people each day
across national boarders and the growth of international trade in goods
are responsible for increased health risks, including infectious diseases,
contaminated foods, and biological and chemical threats.
The new globalhealth.gov Web
site is administered by HHS' Office of International and Refugee Health.
FOLIC ACID
USE DOES NOT INCREASE THE RISK FOR MISCARRIAGE--Findings from a new
study in China show that consumption of folic acid as a vitamin pill to
reduce the risk of neural tube birth defects is safe, and does not
increase a woman’s risk of having a miscarriage.
The study published in the Sept. 8th issue of Lancet, was conducted by the
Centers for Disease Control and Prevention (CDC) and Peking University
Health Sciences Center, China. It focuses on women who had taken part in a
project to prevent neural tube birth defects by taking 400 micrograms of
folic acid a day in pill form.
Researchers found that the risk for miscarriage was essentially the same
among women who did and did not take the folic acid vitamin pill. This
study was the first to evaluate the risk of miscarriage in a large
population of young women who were pregnant for the first time, and who
had documented records of precisely how much folic acid they took before
and during early pregnancy. In addition, women in this study took only
folic acid, without other added vitamins.
For this evaluation, the authors compared the rates of miscarriage among
women who took the folic acid pill as part of the public health campaign
and those who did not take folic acid. The rate of miscarriage was
slightly lower (9.0 percent) for women who took any folic acid before and
during early pregnancy than for women who did not take any folic acid (9.3
percent).
ALCOHOL
RESEARCHERS SHOW "FRIENDLY" VIRUS SLOWS HIV CELL GROWTH --A team of
alcohol researchers led by Jack Stapleton, M.D., of the Department of
Internal Medicine, University of Iowa College of Medicine and the Iowa
City Veterans Affairs Medical Center, report in the September 6 New
England Journal of Medicine, Volume 345, 2001 (Effect of co-infection with
GB virus type C (Hepatitis G Virus) on survival of HIV-infected
individuals: In vitro co-infection suggests inhibition of HIV replication
by GB virus C) that GB virus type C (GBV-C) appears to have retarded the
progression of human immunodeficiency virus in a 12-year clinical study of
HIV patients. Using an infectious molecular clone of GBV-C, the same team
showed in a laboratory study that GBV-C reduces the growth rate of HIV in
cultured human T-cells, a form of white blood cells or lymphocytes.
The clinical finding came while Dr. Stapleton and his colleagues explored
relationships among alcohol, seronegative hepatitis C virus (HCV)
infection, GBV-C infection, and liver disease in patients of the
University of Iowa HIV/AIDS Clinic. Damaging effects of alcohol on immune
function, including effects in patients with HIV and AIDS, are a
long-standing focus of alcohol research.
In the study population of 362 HIV-infected patients, 144 (39.7 percent)
were co-infected with GBV-C, a proportion similar to that of GBV-C
co-infection among all HIV patients. Originally known as hepatitis G, GBV-C
also infects about 15 percent of patients with hepatitis C. Unlike
hepatitis C, however, GBV-C causes neither hepatitis nor any other
clinical symptoms.
"From several earlier studies that examined the relationship of HIV and
GBV-C, we suspected that GBV-C might exert a positive effect toward
slowing the progress of HIV infection. We expanded the previous research
by looking at a very large group of patients followed at our clinic
between 1988 and 2000 and found that HIV-infected people without GBV-C
infection were 3.68 times more likely to die than those with GBV-C," Dr.
Stapleton said. "This leads us to believe that GBV-C is one factor
explaining how some people live longer and more healthily with their HIV
infection than other HIV-infected people do."
NEW SENTINEL SYSTEM WILL MONITOR U.S. BLOOD SUPPLY -- HHS Secretary
Tommy G. Thompson today announced that a new "real time" monitoring
network is being launched to measure the blood supply in key local areas,
regions and nationwide. The new sentinel system will receive daily reports
from selected hospitals and will measure current demand as well as supply
on hand, giving hospitals and blood suppliers a more useful picture of
supplies and possible emerging problems.
The system is to include 29 hospitals, which will provide their daily
reports to HHS. They are located in Boston, New York, Pittsburgh,
Washington, D.C., Atlanta, Miami, Tampa/St. Petersburg, Mobile, New
Orleans, Dallas, Chicago, Indianapolis, Iowa City, Minneapolis, Bismark,
Denver, Seattle, Los Angeles and Tucson. Contracts with the hospitals are
being signed currently.
Exact plans for compiling and sharing the "sentinel" information will be
developed over the coming weeks as the information begins to be provided.
Ultimately, HHS plans to make the information available on a public Web
site.
The new system is being implemented at a cost of about $350,000 per year.
Donna Knutson
Executive Director
Council of State and Territorial Epidemiologists
770-458-3811
770-458-8516
dknutson@cste.org
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